Abstract: Objective To study the relationship between average serum uric acid level and all-cause mortality in maintenance hemodialysis patients at a single center at the beginning of dialysis and 1 year after dialysis. Methods A retrospective cohort study was conducted to observe 122 patients with end-stage kidney disease.The observation period was 5 years.The data of average serum uric acid,albumin,serum calcium,serum phosphorus,hemoglobin and so on were collected at the beginning of dialysis and 3 months,6 months,9 months and 1 year after dialysis.The change trend of serum uric acid was analyzed.According to the levels of uric acid in different periods,the patients were divided into hyperuricemia group(male> 420 μmol/L,female>360 μmol/L)and normal uric acid group(male ≤ 420 μmol/L,female ≤ 360 μmol/L).Kaplan-Meier was used to analyze the difference of all-cause mortality between the high and normal uric acid groups in different periods,and COX regression analysis was used to analyze whether uric acid level is an independent risk factor for all-cause death. Results During the 5-year observation 35 of 122 patients died,with a mortality rate of 28.7%.The average serum uric acid level at the beginning of hemodialysis was(456±121)μmol/L,and the average serum uric acid level one year after dialysis was(409±76)μmol/L,with statistically significant difference(P<0.05).According to the level of uric acid at the beginning of dialysis,there was no difference in all-cause mortality between high uric acid group and normal uric acid group(P=0.125).According to the mean uric acid level one year after hemodialysis,the all-cause mortality of the high uric acid levelgroup was lower than the normal uric acid levelgroup(P=0.004).Multivariate COX regression analysis suggested that after rectifying for age,sex,albumin,creatinine and Kt/V,hyperuricemia was an independent protective factor for all-cause death,and its odd ratio was 0.320 times the normal uric acid.At the same time,the patients in the high uric acid group are younger and the serum creatinine level is higher than that in normal uric acid group,with rectifying differences. Conclusions Patients with end-stage renal disease usually have a high level of uric acid at the beginning of hemodialysis and can reach a stable level one year after hemodialysis.Patients with high and normal uric acid levels have no difference in mortality at the beginning of dialysis.Patients with high uric acid have a higher survival rate when they are grouped by uric acid levels one year after hemodialysis.